Influence of oral tobacco versus smoking on multiple sclerosis disease activity and progression

Abstract

We aimed to study the influence of smoking habits, exposure to passive smoking and snuff use on disease progression, cognitive performance and quality of life in patients with multiple sclerosis (MS).MethodPatients from two population-based case–control studies were categorised based on tobacco exposure at diagnosis and were followed up to 15 years post diagnosis through the Swedish MS registry (n=9089) regarding changes in Expanded Disability Status Scale (EDSS), Multiple Sclerosis Impact Scale 29 and Symbol Digit Modalities Test. We used linear mixed models to analyse long-term changes, and Cox regression models with 95% CI using 24-week confirmed disability worsening, reaching EDSS 3 and EDSS 4, respectively, physical and psychological worsening and cognitive disability worsening as end points. The influence of smoking cessation post diagnosis was also investigated.ResultsCompared with non-smokers, current smokers had a faster EDSS progression (βcurrent smoking×time=0.03, 95% CI 0.02 to 0.04). A faster EDSS progression was also associated with passive smoking (βcurrent passive smoking×time=0.04, 95% CI 0.03 to 0.06). Smoke exposure negatively impacted all secondary outcomes. Those who continued smoking had worse outcomes than those who stopped smoking post diagnosis. Snuff users had a more favourable EDSS progression, compared with never users.ConclusionsOur findings indicate that both smoking and passive smoking have a negative influence on MS and that smoking cessation post diagnosis may be an important secondary preventive measure. Snuff use was associated with slower disease progression, suggesting that nicotine replacement therapy could be an attractive way to increase the chance of quitting smoking among patients with MS.

Sex differences in multiple sclerosis relapse presentation and outcome: a retrospective, monocentric study of 134 relapse events

“…An interrelation of these two factors is likely. However, whether the higher EDSS in men is driven by the longer disease duration or additionally influenced by smoking behavior, as robustly shown before, 15 – 20 cannot be answered by our data. Of note, persons experiencing their first clinical relapse (31.3%) were not included in this pre-relapse EDSS, which is why we refrained from calculating the EDSS difference pre- to during relapse.…”

“…For both factors, exposure rather seems to be cumulative and thus represent a long-term contributor to worse (smoking) or better (DMT) prognosis. 2 , 8 , 18 – 20 Previous smoking behavior was not available for our analysis, but may be a relevant mediating factor for relapse outcome.…”

“… 3 , 9 Taken together, these data with poorer relapse recovery and more motor involvement in men might suggest a general effect of male sex on higher disability progression 11 indicating that additional factors must play a role. Among the latter surely are patient age, disease duration, and disease-modifying treatment (DMT), 2 , 10 , 13 but also individual and possibly gender-influenced behavioral factors, especially smoking 15 – 20 and obesity. 21 …”

Risk Factors for Cognitive Impairment in Multiple Sclerosis Patients

“…Table 1 summarizes the major risk factors associated with cognitive impairment in MS, highlighting possible underlying pathophysiological and relevant references published in the last ten years. Diet Gut-brain axis Renin-angiotensin-aldosterone system [41][42][43][44] Lack of physical exercise To be determined [45,46] Smoking Increased plaque load Reduced gray matter fraction [47][48][49][50] Vitamin D deficiency…”

Health behaviors of people with multiple sclerosis and its associations with MS related outcomes: a German clinical cohort

“…Smoking increases the risk of developing MS ( 15 ) and is associated with a lower QoL and higher impairment ( 16 ). Although smoking cessation has significant benefits for pwMS ( 17 ), no programs have been evaluated in MS populations.…”